November the 6th saw the end of the American Public Health Association’s (APHA’s) 141st Annual Meeting and Exposition held in Boston. With a program full of exciting sessions and events, the largest public health gathering in the world brought together over 12,500 public health enthusiasts including influential advocates, researchers and practitioners. BMC Public Health was lucky to be a part of this group and witness to the dissemination of a wide array of new research relating to this year’s theme.
The theme – “Think Global, Act Local: Best Practices Around the World” emphasized the importance of learning from the best public health practices around the globe and using these to solve local problems. The Opening General Session, which included an address by acclaimed epidemiologist Sir Michael Marmot, kicked off the Annual Meeting and highlighted the need for public health professionals to act as leaders and advocate programs to see positive changes in the field. The Session also announced APHA’s new brand and tagline in light of the organization’s recommitment to its values and goals: For science. For action. For health.
The Affordable Care Act
It’s no surprise that, in light of the October 1st launch of the new Health Insurance Marketplaces and the expected January 1st expansion of Medicaid and marketplace plan coverage to millions of Americans, the Affordable Care Act (ACA) was a major theme covered at the meeting. APHA has been key in the promotion and protection of public health provisions in the ACA and hosted more than 50 sessions dedicated to the reform. Public health systems transformation, violence prevention, the challenges of tobacco use prevention and racial and ethnic disparities in the ACA’s coverage were just a few of the areas discussed in this context.
Thinking globally, acting locally
As this year’s theme indicates, the meeting provided an excellent opportunity for scientific and public exchanges of knowledge and views on international and global health issues. In his talk ‘Global Health begins at home’, Dr Richard Derman focused on the importance of looking at the shocking rates of maternal mortality in the USA where, despite the fact that billions of dollars are being spent a year on childbirth related healthcare, the nation ranked 47th for its maternal mortality ratio (of 21 maternal deaths per 100,000 live births, 2010). It also ranked 47th (along with two other countries) for its 2011 neonatal mortality rate (of 4.3 neonatal deaths per 1,000 live births).
Maternal mortality has doubled in the USA in the last 25 years, with the rate being disproportionate among disparate populations. Deaths are higher among African Americans as compared to Caucasians, highlighting the importance of looking at health disparities in this context. Earlier this year, BMC Public Health published a highly accessed commentary by Dr Derman on advancing maternal survival which highlights the importance of the need to determine whether and which interventions improve maternal survival with the aim of reducing mortality where rates are high.
A promising success story from Afghanistan, a country where one in seven women will die during pregnancy and childbirth, was presented by Dr Douglas Huber whose project delivered condoms, oral contraceptives and injectables at the household level for over 3700 couples. In spite of spouses’ beliefs that injectable contraceptives may cause infertility, the project proved to be a success. Mullahs helped overcome cultural and religious barriers by educating the community, especially men, for improving maternal and child health by spacing pregnancies and by giving correct contraceptive information. The project – MSH REACH- resulted in increased contraceptive use over 2 years, leading the government and international donors to adopt project innovations for national scale-up.
Perhaps the most heartfelt and passionate talk I attended was that by Patricia Hibberd on the consequences of exposure to household air pollution to pregnant women and their babies. Billions of people in developing nations rely on biomass in the form of wood, charcoal, dung and crop residue as their domestic cooking fuel. In September 2010, the United Nations Foundation announced the Global Alliance for Clean Cook Stoves, a new public-private partnership to save lives, empower women, improve livelihoods and combat climate change. Half of the world’s population live in households which use biomass fuel for cooking and heating which leads to high levels of household air pollution (HAP). 5 millions deaths per year are attributed to HAP which is comprised of carbon monoxide, polyaromatic hydrocarbons and particulate matter.
Exposure to HAP in women increases the risk of hypertension and COPD and effects on their babies include an increase in the risk of being born preterm, low birth-weight or dying in the perinatal period. How bad is HAP is for pregnancy exactly? It’s not yet clear as Dr Hibberd explained since many studies carried out on the subject are of low quality due to the difficulty in measuring exposure, the many confounding factors and poorly defined and measured outcomes.
Dr Hibberd’s Global Network Study focusing on the effects of indoor air pollution on maternal and neonatal outcomes followed 65,000 pregnant women and their babies and found that HAP reduces birthweight and that it also has an effect on perinatal mortality. Although levels of particulates have not been measured yet (the study has only looked at what fuels the households have used), Dr Hibberd stated that this was the next step.
So what needs to be done next? As Dr Hibberd pointed out, the focus needs to be placed on improving household design, replacing cook stoves with new cooking solutions and determining whether these are practical and good enough to achieve health benefits. It’s not going to be easy though – huge challenges involve the need to change community behaviour, supplying clean cook stoves and providing resources to cover the expenses associated with introducing safer solutions.